Shepton Mallet NHS Treatment Centre (SMTC) is able to accept patients with stable co-morbidities corresponding to anaesthetic assessment status ASA-3 (i.e. patients with severe systemic disease that limits their activities).
Ultimately it will be the decision of the SMTC Medical Director or Lead Anaesthetist as to whether a patient is accepted for a procedure.
The decision to accept a patient will depend on accurate and comprehensive clinical information being provided by the patient's GP as well as an anaesthetic assessment at the SMTC.
If you have any questions about the possible suitability of a patient for treatment at SMTC - please call SMTC on 01749 333 600 and ask to speak to the Medical Director.
The following conditions are accepted (as long as the condition is controlled and the patient asymptomatic if on treatment):
CARDIOVASCULAR |
RESPIRATORY |
OTHER |
| Hypertension (systolic <160 mmHg, diastolic < 100 mmHg) | Asthma (peak flow above 200 l/min) | Diabetes |
| Angina | COPD (FEV1 > 50% predicted, O2 sats >92% on room air) | Epilepsy |
| Heart failure (NYC I and II) | ||
| Dysrhythmia | ||
| Patients with valve disease | ||
| Patients taking warfarin due to longstanding Atrial Fibrillation with no history of thromboembolism. | ||
Note - this list is not exhaustive but illustrative of some frequently encountered conditions.
The following conditions are not accepted:
Cardiovascular |
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| Myocardial infarction, angioplasty or coronary stenting - within the last 6 months | ||
| CVA / Recurrent TIAs within the last 12 months | ||
| Implanted ventricular defibrilator or past history of ventricular dysrrhythmia | ||
| Patients taking Clopidogrel | ||
Respiratory |
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| Severe COPD FEV1 < 50% predicted. O2 Sats < 92% on room air | ||
| SOB at rest / minor exertion. | ||
| Bronchiectasis (severe) | ||
Other |
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| Myleodysplasia, Haemophilia, Thrombocytopenia | ||
| Presence of infected skin lesions or any ongoing infection | ||
| Chronic ulceration with cellulitis | ||
| Active or severe liver disease | ||
| Immunocompromised HIV or active Hepatitis B or C | ||
| Unstable mental health | ||
| Significant cognitive impairments | ||
| Current MRSA positive (or negative eradication swabs in excess of 1 month from due admission date) | ||
| PROCEDURE | ||||
Cardiovascular |
MAJOR | MINOR |
DIAGNOSTIC ENDOSCOPY
|
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| Patients with valve replacements | No | No | Yes | |
| Pacemaker in situ - functional | No | No | Yes | |
Renal |
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| Renal failure or impairment (creatinine > 200 umol/L) | No | Yes* | Yes | |
Endocrine |
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| Rare Endocrine disorders e.g. Addison's Disease, Cushing's syndrome | No | Yes* | Yes* | |
Blood disorders |
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| Sickle cell disease | No | Yes | Yes | |
| Known Anaemia (g/dl) | Hb>12 | Hb>10 | Hb>10 | |
Other |
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| Age under 18 years | No | No | No | |
| BMI of 40+ or weight > 150kg | No | No | No | |
Yes* - GP to discuss referral with SMTC lead anaesthetist before accepted)
MAJOR PROCEDURE = inpatient treatment
(joint replacement, cholecystectomy)
MINOR PROCEDURE = daycase treatment
(other orthopaedic procedures + general surgery eg hernias)